tbuckley/cabot-search huggingface dataset:
Abstract 14217: Needs Must: A Not-So Benign Pericardial Cyst
Authors: Tanvi Nayak, Gregory Cascino, Madeline Jankowski, Bradley P Knight, Kameswari Maganti
Journal: Circulation (2022)

Mrs. Z is a 56-year-old woman with a long history of symptomatic paroxysmal supraventricular tachycardia (PSVT) who presented with neck and back pain. MRI of cervical and thoracic spine revealed an abnormal signal in the right mediastinal area. A chest CT demonstrated a lobulated 5.8 x 5.5 x 3.5 cm, fluid density lesion contiguous with the pericardium adjacent to right atrium (RA) and inferior venacava (IVC) without wall thickening or solid components, consistent with a pericardial cyst (PC). A transthoracic echo (Panel B) revealed normal left ventricular size and systolic function with an EF of 66%. An echolucency adjacent to the RA and IVC consistent with a pericardial cyst was noted without any extrinsic compression. Given her asymptomatic presentation and normal cardiac imaging, a shared decision was made to conservatively manage.Two years ago, she underwent ablation for AVNRT, followed by an ablation for atrial tachycardia (AT). She continues to have short, symptomatic runs of AT ( Panel A ). A recent CMR re-demonstrated a large, septated pericardial cyst (6.2 x 5 cm) abutting the RA and IVC ( Panel C ). Given her on-going symptomatic SVT, she is referred for robotically assisted thoracoscopic surgery despite stability in size. Discussion: PCs are rare but typically benign. They are the third most common and account for 6% of mediastinal masses. They can be congenital or acquired, simple or complex, and have a predilection for R costophrenic angle (50-70%) followed by the L costophrenic angle (28-38%). Although most are asymptomatic and diagnosed incidentally, they sometimes can result in symptoms such as chest pain, dyspnea, and paroxysmal tachyarrhythmias. Large PCs can lead to tamponade. If a PC is suspected by CXR or echo, cardiac CT or CMR are used for confirmation. Periodic imaging is recommended every 1-2 yr. Most PCs resolve spontaneously. Treatment options include aspiration or surgical resection. Minimally invasive surgical options appear to be the best.
Abstract 14141: A Novel Endothelial Function Test in Predicting Late Coronary In-Stent Restenosis
Authors: Zhuoran Yang, Jiasheng Yin, Yaqi Zhang, Lingling Wu, Jieyu Jiang
Journal: Circulation (2022)

Introduction: Endothelial dysfunction is related with in-stent restenosis (ISR) of prior drug-eluting stents (DES) implanted more than 1 year ago (late ISR). EndoPAT is a novel non-invasive test quantifying endothelial function as reactive hyperemia peripheral arterial tonometry index (RHI). Hypothesis: EndoPAT is a potential predicting test for late ISR. Methods: We conducted a case control study on 186 patients with coronary DES implanted more than 1 year ago in a single medical center. Those who had contraindications to EndoPAT test, acute myocardial infarction, coronary artery bypass graft (CABG), chronic kidney disease (CKD) stage III and above, active infection and rheumatologic disease or acute decompensated heart failure were excluded. Patients were divided into ISR and non-ISR group based on coronary angiography. EndoPAT test was done at 24 to 48 hours prior to catherization. LnRHI is an index after natural log transformation of RHI. A receiver operative characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of LnRHI for predicting late ISR. Results: ISR group had significantly more patients with history of ISR or triple-vessel disease, longer stent length and fewer totally occlusive lesions than non-ISR group. LnRHI was significantly lower in ISR group than in non-ISR group (0.66 vs 0.50, p&lt;0.01). Patients with diffuse ISR had lower LnRHI than those with focal ISR (0.40 vs 0.55, p=0.03). Patients without ISR but undergoing revascularization had lower LnRHI than those with patent coronary arteries (0.56 vs 0.70, p=0.02). Endothelial function quantified by LnRHI was an independent risk factor for ISR (LnRHI/0.1, OR=0.79, 95% CI 0.64-0.97, p=0.03). The ROC curve analysis showed LnRHI of 0.44 had a sensitivity of 81.7% and specificity of 53.8% for predicting late ISR. Conclusions: Endothelial dysfunction measured by EndoPAT had a clinical potential for predicting the development of late ISR.
Abstract 13950: Dynamic Myocardial Systolic and Diastolic Response to Exercise in Patients After the Fontan Operation
Authors: Boekhren Karyostyko Borhanuddin, Andreea Dragulescu, Cameron Slorach, Wei Hui, Chun-po S Fan, brigitte Mueller, Barbara Cifra, Luc L Mertens
Journal: Circulation (2022)

Background: Exercise capacity is one of the predictors of morbidity and mortality in patients after the Fontan circulation. The influence of myocardial systolic and diastolic functional reserve on exercise performance has not been well established in this population. This study aimed at studying the myocardial response to exercise in Fontan patients using exercise echocardiography. Methods: Twenty-three Fontan patients with baseline ejection fraction &gt;55% and 23 age and gender matched controls were included. A stepwise exercise stress echocardiography protocol was used. Tissue Doppler imaging (TDI) systolic (s’), and early diastolic (e’) velocities and myocardial acceleration during isovolumic contraction (IVA) were measured in the free wall of the dominant ventricle and interventricular septum and in the left ventricular free wall and septum of controls. Measurement was taken at rest and at incremental heart rate (HR). Changes in tissue Doppler velocities versus heart rate were studies and compared between patients and controls. Results: Resting HR was not significantly different between patients and controls but peak HR was lower in the Fontan group vs controls ( p &lt;0.001). At rest patients had significantly lower lateral and septal e’ and s’ compared to controls (lateral s’: 6.35±1.05 vs. 14.41± 1.88 cm/s; lateral e’: 9.38±1.71 vs.20.66±2.55 cm/s; septal s’: 5.30±2.46 vs. 11.58±2.26 cm/s; septal e’: 10.45±2.46 vs. 17.80±1.58 cm/s P &lt;0.001) except for IVA. At peak exercise, all variables were significantly lower in the patient group. During exercise, the slopes of lateral and septal s’ and IVA were significantly different between patients and controls except for e’. Conclusion: Our data suggest that patients with Fontan physiology have blunted systolic contractile response to exercise. Surprisingly our data suggest that the dynamic early diastolic myocardial reserve is preserved which suggest that early myocardial relaxation is not a limiting factor.
Abstract 13909: Use of Advanced Lipoprotein Testing in Real-World Data: A Cross Sectional Study Across Multiple Health Systems
Authors: Hetal Boricha, Yousef Alish, Michael Becich, Alison Bradley, Soledad Fernandez, Dan Ford, Wenke Hwang, Jong Jeong, Martha Jurczak, H Lester Kirchner, Kathleen M McTigue, Richard Morgan, Anuradha Paranjape, Neena Thomas, David Williams, Jonathan Arnold
Journal: Circulation (2022)

Introduction: Per AHA guidelines, adults between 40-75 with borderline (5-7.5%) 10-year ASCVD risk (approximately 2.5% of this population in prior studies) should have the decision to start statin therapy personalized. Per AHA guidelines, elevated apolipoprotein B-100 (apoB) and elevated lipoprotein(a) (Lp(a)) are risk enhancing factors that may be considered in this decision. Hypothesis: We hypothesize that &lt;10% of the estimated borderline 10-year ASCVD risk population between 40-75 years of age are tested for apo(B) or Lp(a). Methods: We performed a hypothesis-driven secondary analysis of a cross-sectional dataset of adults with LDL-c assessed in the most recent year of available data from 7 health systems participating in PaTH, a Partner Network in PCORnet. Participating sites reported summaries of demographics, diagnoses and lab testing for their health system populations as well as sub-cohorts of patients with prior ASCVD events, diabetes (DM), and a history of LDL &gt; 190mg/dl. We evaluated the lifetime testing for apo(B) and Lp(a) in the whole population and subtracted out the testing in the high-risk cohorts. Results: From a population of 784,406 adults, we identified a cohort of 301,235 aged 40-75 without prior ASCVD event, DM, or LDL &gt; 190. We estimated that 2.5% of this population (7,531) had borderline 10-year ASCVD risk. A total of 730 individuals were tested for apoB and 892 for Lp(a) across the entire non-high-risk cohort (0.2% and 0.3%). Assuming only the borderline risk group was tested, this represents testing rates of 9.7% for apoB and 11.8% for Lp(a), ranging across healthcare systems from 0-27% for apoB and 0-42% for Lp(a). Conclusions: Within the constraints of our population-based cross-sectional study, we found it plausible that &gt;10% of the borderline-risk population utilized either apoB or Lp(a) testing for further risk stratification. Future work should be done to directly evaluate the use of these parameters in the borderline-risk population.
Abstract 13930: The Impact of a Remote Patient Monitoring Program on Blood Pressure Control, Glycemic Control, and Lipids in Patients With Hypertension: A 3.5-year Retrospective Analysis Across 39 Physician Practices
Authors: Li Wang, Zhiyu Liu, Nina Ghamrawi, Shuo Liu, Nathan Wong
Journal: Circulation (2022)

Introduction ​​Self-measured blood pressure monitoring (SMBP) is recommended for hypertension (HTN) management and remote patient monitoring (RPM) can empower clinicians to manage HTN more efficiently. We examined the impact of a digital health program integrating RPM, SMBP, and nutrition/lifestyle coaching for patients with HTN. Methods 37 primary care practices and 2 cardiology practices across 10 US states enrolled patients with HTN diagnosis (regardless of their baseline BP control status) into the iHealth Unified Care program from 2018 to 2022. Bluetooth connected devices with mobile app or WIFI connected BP monitors, a web-based clinical care platform, and real time data analytics were utilized. Physicians and their care team, including registered dietitians, provided assessment, goal setting, continuous monitoring, and follow up visits if needed. The 7-day average BP value at baseline and the most recent measurement 7-day period were calculated to analyze BP control status. Results 3364 patients (age: 65.7 ± 12.1 years, 48.7% female) with baseline and endpoint BP data were included. Enrollment was continuous with an average duration in the program of 1.5 years. The baseline average BP was 138/81mmHg and the overall SBP/DBP reduction was -5.3 ± 15.1 / -3.1 ± 8.4 mmHg (P&lt;0.0001) at the endpoint. The proportion with HTN controlled to &lt;130/80 mmHg was increased from 21.8% to 36.0% (P&lt;0.0001), and those controlled to &lt;140/90 mmHg increased from 53.9% to 63.7% (P&lt;0.0001). In a subgroup analysis on patients with Stage II HTN at baseline (n=1552), the SBP/DBP reduction was -11.9 ± 15.4 /-6.3 ± 8.7 mmHg (p&lt;0.0001) and more significant BP reductions were observed after 6 weeks, and further improved at 3 months, 6month, and 12months respectfully. Of patients with diabetes, HbA1c was reduced by 0.5 ± 1.4% (n=337, p&lt;0.001) and of those with hyperlipidemia (LDL-C &gt;100mg/dL) at baseline (n=264), LDL-C also was reduced significantly (-19.6 ± 38.4 mg/dL, P&lt;0.001). Conclusions: The digital BP monitoring program significantly improved the BP control in patients with HTN as well as HbA1c and LDL-C in those who also had diabetes and hyperlipidemia, respectively. Long term and randomized control trials are needed to further evaluate the impact on cardiovascular risk.
Abstract 14306: Development of Sleep-Disordered Breathing Destabilizes Ventricular Repolarization
Authors: Soroosh Solhjoo, Mark C Haigney, Ciprian M Crainiceanu, Abigail Koch, Trishul Siddharthan, Naresh Punjabi
Journal: Circulation (2022)

Introduction: Sleep-disordered breathing (SDB) is a prevalent condition associated with adverse cardiovascular events, including nocturnal arrhythmias and sudden cardiac death, but the underlying mechanism is unclear. Hypothesis: Ventricular repolarization instability increases in those who develop SDB. Methods: For the participants of the Sleep Heart Health Study (SHHS), the percentage of sleep time with oxygen saturation levels &lt; 90% (T90) was measured. We identified participants who did not have SDB (T90 &lt; 0.22% = median of the SHHS cohort) during the initial study but developed SDB (T90 &gt; 10%) by the time of the 5-year follow-up. A comparator group was identified as those who matched the first group on age, sex, BMI, and race but had T90 &lt; 0.22% during both the initial and the follow-up sleep studies. Each group consisted of 25 (8 M and 17 F) participants, none of whom had any diagnosed comorbidities or prescriptions that could affect cardiac repolarization. Heart rate (HR), heart rate variability (SDNN), and QT variability index (QTVI, a measure of ventricular repolarization instability) were calculated from one-lead ECG recordings. Paired sample t- test was used to assess statistical associations. Results: The respiratory disturbance index (RDI) for the study group increased from 2.57 ± 0.74 events/hr at baseline to 14.8 ± 3.72 events/hr at follow-up (P = 0.001), while the RDI was not different for the comparators (3.08 ± 0.71 events/hr at baseline, 3.65 ± 0.68 events/hr at follow-up, P = 0.599). In those who developed SDB, HR and SDNN did not change between baseline and follow-up, but QTVI increased from -1.25 ± 0.15 to -0.85 ± 0.15 (P = 0.013). None of the measured electrocardiographic parameters differed between baseline and follow-up in comparators. Conclusion: Over a five-year follow-up, the development of SDB was associated with an increase in QT variability comparable to symptomatic heart failure. Hypoxemia appears to be the main underlying mechanism.
Abstract 12905: Prevalence of Cardiovascular Disease in Mid-Life Among Women Who Have Had a Child With Congenital Heart Disease
Authors: Stephanie Colello, Richard Ittenbach, Brenna Klepczynski, Nancy Burnham, Andrew Messersmith, J W Gaynor, Jennifer Lewey
Journal: Circulation (2022)

Background: Women whose offspring have congenital heart disease (CHD) have higher risk of cardiovascular (CV) disease and mortality later in life. The mechanism is not well-understood and may be related to angiogenic imbalance, genetic predisposition, or stress-related pathways. We aimed to describe the prevalence of CV disease and traditional and sex-specific risk factors among women with a child with CHD at 18-23 years after delivery. Methods: We conducted an online survey among mothers whose infants had undergone cardiac surgery before six months of age and enrolled in a prospective observational study at the Children’s Hospital of Philadelphia. Maternal surveys investigated sociodemographic characteristics and self-reported health behaviors and medical history. We described the prevalence of baseline characteristics. Results: 531 women were contacted and 220 (41%) completed the survey and are included in this analysis. Child and maternal characteristics are presented in Table. Mean maternal age was 52 years, 86% were White, and 68% completed college. Regarding sex-specific risk factors, 10% had preeclampsia and 32% had history of preterm delivery. The most common traditional CV risk factors were high cholesterol (32%) and hypertension (27%). Overall, 4.6% of women reported a history of atherosclerotic cardiovascular disease (ASCVD) and 15% reported any cardiac disease, as defined by arrhythmia, structural heart disease, or ASCVD. Of the 6 women with prior myocardial infarction (2.7%), mean age at onset was 44 years. Complexity of the child’s CHD was significantly associated with prevalence of ASCVD but not other types of CV disease (p=0.008) Conclusion: Having a child with CHD is a potentially important sex-specific CV risk factor that is not well-studied. Understanding how this maternal characteristic interacts with other traditional and sex-specific risk factors is critical to understanding mechanistic pathways leading to CV disease in these women.
Abstract 13162: Temporal Trends in Secondary Pulmonary Hypertension and Subsequent Mortality in Hospitalized Geriatric Patients With Prior Revascularized Myocardial Infarction (2016-2019)
Authors: Koushik Sanku, Nishanth Katukuri, Adhvithi Pingili, BORZOO TAJDIN, Tamer Zahdeh, Akhila S Cherukuri, HAMIDREZA JALILI, Pooriya Bahadoran, Sashwath Srikanth, Rupak Desai
Journal: Circulation (2022)

Background: There is limited data on the burden and impact of Pulmonary hypertension (PHTN) in geriatric patients with prior revascularized MI. This study aims to explore the burden, trends, and impact of secondary PHTN on the survival of elderly patients with established CVD risk. Methods: We used the National Inpatient Sample (2016-2019) to identify geriatric (≥65 years) hospitalizations with prior revascularized MI (PCI or CABG) by using ICD-10 codes and divided them into two groups: with secondary PHTN and without secondary PHTN (GPRMI-PHTN+ VS. GPRMI-PHTN-). We then compared the two groups' morbidity, mortality, and associated outcomes. Results: Of 2265900 GPRMI patients that were included in the study, 169942 (7.5%) had secondary PHTN (median 76 [70-82]). The PHTN cohort often had females (42.5% vs 33.7%) and blacks (10.8% vs 7.7%) than the cohort without PHTN (p&lt;0.001). The PHTN group often consisted of higher rates of diabetics (49.8% vs 46.3%) and smokers (45% vs 43.9%) (all p&lt;0.005). The PHTN cohort had a higher all-cause mortality rate (3.7% vs 2.6%), often required home health care (26.7% vs 21.3%), transfers to other care facilities (23.4% vs 21.7%), with prolonged hospital stays (median 4 vs 3 days), and had higher hospital costs (all p&lt;0.005). A significant decline in morbidity and mortality was noted temporally among males, females, and whites, but not in black, hispanic, and asian populations. Conclusions: PHTN is strongly associated with morbidity and mortality in geriatric patients with a prior history of revascularized MI. Prospective studies on such patients with long-term follow-up are warranted to establish trends and disparities among different populations and prevent worse outcomes.
Abstract 13550: Electrocardiographic-Based Artificial Intelligence Model in Prediction of 1-year Mortality in Heart Failure With Reduced Ejection Fraction
Authors: Hak Seung Lee, Sora Kang, Jong-Hwan Jang, Yong-Yeon Jo, Jeong Min Son, Min Sung Lee, Joon-Myoung Kwon
Journal: Circulation (2022)

Objectives: To assess whether electrocardiography (ECG)-based artificial intelligence (AI) algorithm developed to detect 1-year mortality in patients with HF with reduced ejection fraction (HFrEF). Methods and results: Data from two hospital visits (2016 Oct to 2021 Apr) was used. Participants with good quality baseline ECGs and HFrEF were included. We tested the hypothesis that the application of AI to the ECG could identify 1-yr mortality in HFrEF patients. A total of 16,228 (64% male, mean age of 58.5) were eligible. When tested on an independent set of 16,228 patients, the network model yielded values for the area under the curve, sensitivity, specificity, and accuracy of 0.83, 83.3%, and 64.2%, respectively ( Figure a ). Those with a positive AI screen were at 2.6 times the risk (p&lt;0.0001) of developing future mortality compared with those with a negative screen ( Figure b ). We used a sensitivity map to visualize the ECG region used in the AI model to detect high 1-yr mortality in HFrEF ( Figure c ). The map shows that the AI model focused on the QRS complex, particularly the R-wave, in most patients. Conclusions: The application of AI to the ECG permits the ECG to serve as a powerful screening tool for detecting 1-yr mortality in HFrEF. Figure a. The area under the curve of the convolutional neural network used to identify 1-year mortality of heart failure with reduced ejection fraction. Figure b. Long-term incidence of mortality in patients with initially 1-year mortality stratified by artificial intelligence classification. Figure c. Sensitivity map of a deep learning model for detecting 1-year mortality in heart failure with reduced ejection fraction.
Abstract 14109: Safety and Effectiveness of Trans-Catheter Tricuspid Valve Repair in the Elderly and Very Elderly Patients
Authors: Victoria Soellner, Steffen Schnupp, Issameddine Ajmi, Majdi Amami, Christian Mahnkopf
Journal: Circulation (2022)

Introduction: Symptomatic tricuspid regurgitation (TR) is associated with a high mortality rate and high HF-related hospitalization. Symptomatic therapy in the elderly and very elderly patients remains weak in controlling severe TR. Patients with an increased risk of surgical repair of the TR seemed to benefit from transcatheter tricuspid valve repair procedures. Hypothesis: Therefore, we thought to analyze the postprocedural safety and success of the transcatheter tricuspid valve repair in octogenarians and older patients. Methods: Elderly patients with severe and symptomatic TR were presented and evaluated in the heart team. Patients with high surgical risks underwent transcatheter tricuspid valve repair procedures in our center. Post-procedural transthoracic echocardiography (TTE) procedure was performed to determine the TR grade and exclude procedure-related complications. Results: Thirty-three consecutive patients, older than 80 years (84.45 ±3.12, 14 men and 19 women, who received transcatheter TR repair between September 2021 and January 2022 were enrolled. The baseline characteristics are presented in table 1. Procedural success, defined as reducing the TR to grad I-II, was achieved in 97 % of the patients (3.79±0.65 vs. 1.55±0.56, P = 0.011). All patients improved in the New York Heart Association functional class (2.85±0.50 vs. 1.39±0.056 30 days after the intervention). No procedure-related death was registered. 87.9 % (n=29) survival rate was achieved 3 months after the intervention. No clip embolization was detected in 3 months echocardiography control. Conclusions: Our preliminary results indicate that transcatheter tricuspid valve repair procedures are safe and effective therapeutic option in elderly and very elderly patients with severe TR and high surgical risks. Therefore, this therapy should be considered despite age and comorbidities for effective symptomatic treatment in this cohort.